Common diagnosis of hip pain: dysplasia

When caught in time, surgery can result in normal function

Most people first hear of hip dysplasia in connection with large, purebred dogs. However, hip dysplasia is also a significant issue in humans. Nearly 80 percent of patients with dysplasia are women. It can be passed on from one generation to the next. Dysplasia predisposes to osteoarthritis and, in fact, is the leading diagnosis in patients who eventually undergo total hip replacement.

Hip dysplasia is not a disease, but rather a condition brought on by abnormal development of the shape of the hip joint. Think of it as an engineering “mistake,” like a car fitted with a tire that is too small. That tire will wear out prematurely and/or rupture. That’s what happens to the hip joint when the socket of the pelvis is too small for the femoral head.

The stresses on the cartilage rise to levels that cause it to break down, leading to osteoarthritis. Actually, many women get their first symptoms during pregnancy. Early on, symptoms usually involve activity or sports-induced aches in the groin, which are often initially diagnosed as tendinitis or groin-pull. As the condition progresses, symptoms include limping, pain, stiffness, clicking and popping and decreased capacity to walk and stand.

Before the onset of advanced arthritis, osteotomy surgery (PAO or periacetabular osteotomy) can be performed to improve the architecture of the hip joint. Most often, this is done by detaching the socket from the pelvis, rearranging the position and then reattaching the socket with screws. When it is done in time, pain goes away and function improves, often to normal levels.

It is sometimes possible to avoid surgery by modifying activities, curtailing strenuous sports, careful use of over-the-counter pain medications, such as acetaminophen, ibuprofen and naproxen, losing weight and joint-protective aerobic and strengthening exercises.

It is very important not to ignore the early warning signs such as onset of pain regularly after a jog or after a soccer match or during a pregnancy, etc.

Swimming pool and stationary bike exercises are particularly good strategies as they help to lubricate and nourish the joint surfaces. Running, stair climbing and impact sports are not recommended for people with hip dysplasia.

Tai Chi and yoga are disciplines with movements than can help promote strength, flexibility and balance. Exercise can improve your muscle strength, posture, and overall health, but exercise alone cannot change the bone structure of your hip joint.

If you’re having pain in the groin or the front of the hip that persists or gets worse, you should have it checked out. During a physical exam your physician can check for an increase of internal rotation over external rotation. Also, your doctor can check for hip discomfort during movement (especially flexion, adduction and internal rotation), clicking (during flexion, abduction and external rotation), limping and differences in leg length.